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1.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi ; 54(11): 837-842, 2019 Nov 07.
Artigo em Chinês | MEDLINE | ID: mdl-31795545

RESUMO

Objective: To investigate the potential risk factors for the death of patients underwent gastric pull-up reconstruction following total pharyngoesophagectomy during perioperative periods. Methods: A total of 71 patients, including 64 males and 7 females, aged from 35 to 72 years old, with hypopharyngeal or cervical esophageal carcinoma, who underwent gastric pull-up reconstruction after pharyngoesophagectomy between October 2008 and October 2017, were reviewed retrospectively. Seventeen factors which may have potential influence on the mortality of patients during perioperative periods were evaluated by single factor Logistic regression analysis, and then those factors with obvious difference in statistics were further analyzed by multi-factor Logistic regression. Results: The rate of perioperative mortality was 9.9% (7/71). Single factor Logistic regression analysis indicated that the age of patients, abnormal electrocardiogram, TNM stages, alanine aminotransferase and D-Dimer changes, postoperative bleeding were risk factors for the death of patients(P values were 0.023, 0.004, 0.026, 0.021, 0.015 and 0.002, respectively). Multi-factor Logistic regression showed that postoperative bleeding and D-Dimer changes were 2 independent risk factors for perioperative death(P=0.021 and 0.047, respectively). Conclusions: Many potential factors may affect the perioperative mortality of patients underwent gastric pull-up reconstruction following total pharyngoesophagectomy. Postoperative bleeding and significantly elevated D-Dimer level were independent risk factors for the death of patients, indicating poor prognosis.


Assuntos
Neoplasias Esofágicas/cirurgia , Esofagectomia/mortalidade , Esôfago/cirurgia , Faringectomia/mortalidade , Faringe/cirurgia , Estômago/cirurgia , Adulto , Idoso , Anastomose Cirúrgica/mortalidade , Neoplasias Esofágicas/sangue , Feminino , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Humanos , Masculino , Pessoa de Meia-Idade , Hemorragia Pós-Operatória/sangue , Hemorragia Pós-Operatória/etiologia , Hemorragia Pós-Operatória/mortalidade , Procedimentos Cirúrgicos Reconstrutivos/mortalidade , Estudos Retrospectivos , Fatores de Risco
2.
Arq Gastroenterol ; 56(4): 377-385, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31618397

RESUMO

BACKGROUND: Biomarkers from routine complete blood count are known predictive factors of long-term outcomes in cancer patients. The value of these biomarkers in the setting of trimodal therapy for esophageal cancer in predicting early postoperative outcomes is not studied. OBJECTIVE: The present study evaluated the value of cellular blood components changes during neoadjuvant chemoradiotherapy followed by curative intent esophagectomy for cancer in predicting postoperative mortality and morbidity. METHODS: A cohort of 149 consecutive patients that underwent chemoradiotherapy using platinum- and taxane-based regimens followed by esophagectomy was analyzed. Cellular components of blood collected before neoadjuvant therapy (period A) and before surgery (period B) were assessed for postoperative mortality and complications. Univariate and multivariate Cox regression models were applied to evaluate the independent prognostic significance of blood count variables. RESULTS: Postoperative morbidity was present in 46% of the patients. On multiple regression analysis platelet volume (B) (OR: 1.53; 95% CI: 1.2-2.33) was an independent predictor of general complications. Severe postoperative surgical complications were present in 17% of the patients. On multiple regression analysis, lymphocyte decrease between B-A periods (OR: 0.992; 95% CI: 0.990-0.997) was related to higher risk for severe complications. Cervical anastomotic leakage was present in 25.6% of the patients. On univariate analysis eosinophil count in A and B periods was related to cervical anastomotic leakage. For this outcome, multivariate joint model could not identify independent risk variables of cellular components of blood. The 30-day mortality rate was 7.4%. On univariate analysis, platelet count in period B was associated to higher risk for mortality. The multivariate joint model could not accurately predict mortality due to the few number of patients in the mortality group. CONCLUSION: This is the first study to assess the relationship between peripheral blood count variables changes during neoadjuvant chemoradiotherapy using a platinum- and taxane-based regimen followed by curative intent esophagectomy for cancer in predicting postoperative complications. The platelet volume prior to surgery is related to postoperative complications and the lymphocyte count change prior to surgery predicts severe postoperative complications in the setting of trimodal therapy for esophageal cancer.


Assuntos
Neoplasias Esofágicas/mortalidade , Neoplasias Esofágicas/cirurgia , Esofagectomia/mortalidade , Contagem de Linfócitos , Volume Plaquetário Médio , Idoso , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Complicações Pós-Operatórias , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Fatores de Risco
3.
Medicine (Baltimore) ; 98(43): e17531, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31651855

RESUMO

Lymph node metastasis (LNM) of esophageal squamous cell carcinoma (ESCC) has important prognostic significance. In this study, we examined the correlations between lymph node metastatic sites and prognosis in patients with resectable ESCC.A total of 960 patients who received curative esophagectomy with systemic lymphadenectomy between 1996 and 2014 were included in the retrospective analysis. The Kaplan-Meier method and log-rank test were used to perform the survival analysis. The prognostic significance of LNM site was evaluated by Cox regression analysis.The LNM in middle paraesophageal (P < .001), subcarinal (P < .001), lower paraesophageal (P < .001), recurrent laryngeal nerve (P = .012), paratracheal (P = .014), and perigastric (P < .001) sites were associated with poor prognosis in univariate analysis. In multivariate analysis, only middle paraesophageal LNM (MPLNM, P = .017; HR, 1.33; 95%CI, 1.05-1.67) was the independent factor for worse prognosis. Additionally, patients with MPLNM had a lower 5-year survival rate (15.6%) than those with LNM at other sites. Furthermore, upper or middle tumor location and relatively late pN stage were associated with increased risk of MPLNM.Our findings suggested MPLNM could be a characteristic indicating the worst prognosis. Preoperative examinations should identify the existences of MPLNM, especially on patients with risk factors. And patients with MPLNM should be considered for more aggressive multidisciplinary therapies.


Assuntos
Neoplasias Esofágicas/mortalidade , Carcinoma de Células Escamosas do Esôfago/mortalidade , Esofagectomia/mortalidade , Excisão de Linfonodo/mortalidade , Linfonodos/patologia , Idoso , Neoplasias Esofágicas/patologia , Carcinoma de Células Escamosas do Esôfago/patologia , Esôfago/patologia , Feminino , Humanos , Estimativa de Kaplan-Meier , Linfonodos/cirurgia , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida
4.
Cir. Esp. (Ed. impr.) ; 97(8): 470-476, oct. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-187622

RESUMO

El tratamiento quirúrgico de los adenocarcinomas de la unión esofagogástrica se basa en gastrectomías totales o esofaguectomías oncológicas, procedimientos de alta complejidad y considerable morbimortalidad. Los datos obtenidos del análisis de registros quirúrgicos poblacionales muestran una elevada variabilidad en el enfoque terapéutico y los resultados entre diferentes centros hospitalarios y zonas geográficas. Una de las principales medidas destinadas a reducir esta variabilidad, mejorando los resultados globales, es la centralización de la enfermedad en centros de referencia, proceso que debe basarse en el cumplimiento de unos estándares de calidad e ir acompañada de la armonización de protocolos terapéuticos. La cirugía mínimamente invasiva puede disminuir la morbilidad postoperatoria sin comprometer la supervivencia, pero es técnicamente más demandante que la cirugía abierta. Los programas de formación quirúrgica tutelada permiten incorporar la cirugía mínimamente invasiva a la práctica de los equipos quirúrgicos sin que la curva de aprendizaje condicione la morbimortalidad ni la radicalidad oncológica


Surgical treatment of oesophagogastric junction adenocarcinomas is based on total gastrectomies or oesophagectomies, which are complex procedures with potentially high morbidity and mortality. Population-based registers show a considerable variability of protocols and outcomes among different hospitals and regions. One of the main strategies to improve global results is centralization at high-volume hospitals, a process that should take into account the benchmarking of processes and outcomes at referral hospitals. Minimally invasive surgery can improve postoperative morbidity while maintaining oncological guaranties, but is technically more demanding than open surgery. This fact underlines the need for structured training and mentorship programs that minimize the impact of surgical teams’ training curves without affecting morbidity, mortality or oncologic radicality


Assuntos
Humanos , Adenocarcinoma/cirurgia , Benchmarking , Neoplasias Esofágicas/cirurgia , Junção Esofagogástrica/cirurgia , Neoplasias Gástricas/cirurgia , Esofagectomia/educação , Esofagectomia/mortalidade , Esofagectomia/normas , Gastrectomia/educação , Gastrectomia/mortalidade , Gastrectomia/normas , Complicações Pós-Operatórias/prevenção & controle , Curva de Aprendizado , Serviços Centralizados no Hospital , Hospitais com Alto Volume de Atendimentos
5.
Perm J ; 232019.
Artigo em Inglês | MEDLINE | ID: mdl-31496496

RESUMO

BACKGROUND: Feeding jejunostomy (FJ) tubes are routinely placed during esophagectomy. However, their effect on immediate postoperative outcomes in this patient population is not clear. OBJECTIVES: To evaluate the effect of FJ tube placement during esophagectomy on postoperative morbidity and mortality. METHODS: The National Surgical Quality Improvement Program database was used to evaluate the effect of FJ tube placement during esophagectomy on 30-day postoperative morbidity and mortality rates. A propensity score-matched cohort was used to compare postoperative outcomes of patients with and without FJ tubes. RESULTS: An FJ tube was placed in 45% of 2059 patients undergoing esophagectomy. The anastomotic leak rate was 13.5%. Patients with FJ tubes were more likely to have preoperative radiation therapy (59.6% vs 54.9%, p = 0.041), transhiatal esophagectomy (21.5% vs 19.2%, p = 0.012), a malignant diagnosis (93.2% vs 90.4%), and longer operative time (393 min vs 348 min, p < 0.001). In a case-matched cohort, mortality (2% vs 2.4%, p = 0.618) and severe morbidity (38.2% vs 34.6%, p = 0.128) were comparable between patients with and without FJ tubes. FJ tube placement was associated with higher overall morbidity (46% vs 38.6%, p = 0.002), superficial wound infection (6.3% vs 2.9%, p = 0.001), and return to the operating room (16.7% vs 12.5%, p = 0.016). In a subgroup of patients with anastomotic leak, FJ was associated with shorter hospital stay (20.1 days vs 24.3 days, p = 0.046). CONCLUSION: These mixed findings support selective rather than routine FJ tube placement during esophagectomy.


Assuntos
Nutrição Enteral/métodos , Esofagectomia/métodos , Jejunostomia/métodos , Fístula Anastomótica/epidemiologia , Fístula Anastomótica/etiologia , Estudos de Casos e Controles , Nutrição Enteral/efeitos adversos , Nutrição Enteral/mortalidade , Esofagectomia/efeitos adversos , Esofagectomia/mortalidade , Feminino , Humanos , Jejunostomia/efeitos adversos , Jejunostomia/mortalidade , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Pontuação de Propensão , Estudos Retrospectivos , Resultado do Tratamento
7.
World J Surg Oncol ; 17(1): 146, 2019 Aug 19.
Artigo em Inglês | MEDLINE | ID: mdl-31426805

RESUMO

BACKGROUND: The aim of this study was to compare the outcome of patients with adenocarcinoma of the distal esophagus (AEG type I) treated with neoadjuvant chemoradiation or perioperative chemotherapy. METHODS: Eligible patients from four Austrian centers were selected to conduct a retrospective analysis. All patients treated between January 2007 and October 2017 with chemotherapy according to EOX-protocol (Epirubicin, Oxaliplatin, Xeloda) or chemoradiation according to CROSS-protocol (carboplatin/paclitaxel + RTX 41.4 Gy), before esophagectomy were included. Primary outcomes disease-free survival (DFS) and overall survival (OS) as well as secondary outcomes downstaging of T- or N-stage and achievement of pathological complete response pCR (ypT0N0M0) were analyzed. Data of 119 patients were included. RESULTS: Complete data was available in 104 patients, 53 patients in the chemoradiation group and 51 patients in the chemotherapy group. The mean number of lymph nodes removed was significantly higher in the EOX group (EOX 29 ± 15.5 vs. CROSS 22 ± 8.8; p < 0.05). Median follow-up in the CROSS group was 17 months (CI 95% 8.8-25.2) and in the EOX group 37 months (CI 95% 26.5-47.5). In the chemotherapy group, the OS rate after half a year, - 1, and 3 years was 92%, 75%, and 51%. After chemoradiation, overall survival after half a year was 85 %, after 1 year 66%, and after 3 years 17%. In the EOX group DFS after ½, - 1, and 3 years was 90%, 73%, and 45%, in the chemoradiation group after half a year 81%, after 1 year 55% and after 3 years 15%. Pathological complete response (pCR) was achieved in 23% of patients after CROSS and in 10% after EOX (p < 0.000). CONCLUSIONS: There seem to be clear advantages for chemoradiation, concerning the major response of the primary tumor, whereas a tendency in favor for chemotherapy is seen in regards to systemic tumor control. Furthermore, the type of neoadjuvant treatment has a significant influence on the number of lymph nodes resected.


Assuntos
Adenocarcinoma/terapia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Quimiorradioterapia Adjuvante/mortalidade , Neoplasias Esofágicas/terapia , Esofagectomia/mortalidade , Assistência Perioperatória/mortalidade , Adenocarcinoma/patologia , Áustria , Terapia Combinada , Neoplasias Esofágicas/patologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida
8.
J Cancer Res Ther ; 15(4): 849-856, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31436242

RESUMO

Purpose: This study investigated the outcome of elderly patients (≥65 years) with thoracic esophageal squamous cell carcinoma (TESCC) treated with esophagectomy and postoperative radiotherapy (PORT) or definitive radiotherapy (DRT). Patients and Methods: One hundred and ninety patients (median age of 72 years) who received PORT (n = 68) or DRT (n = 122) for TESCC were analyzed. Majority of them showed locally advanced disease (T3/4: 70.5%, N+: 70.5%, Stage III: 51.6%). Compared to patients who received DRT, those who received PORT had lower Age-Adjusted Charlson Comorbidity Index (AACCI) scores (2.49 ± 0.61 vs. 3.73 ± 1.28, χ2 = 7.283; P = 0.000) and higher Karnofsky Performance Scale (KPS) (χ2 = 9.016; P = 0.003) and were of younger ages (68.90 ± 3.00 vs. 75.17 ± 5.71, χ2 = 9.925; P = 0.000). Results: Overall survival (OS) was significantly higher in the PORT group (median, 61.2 months; 95% confidence interval [CI], 46.04-76.36) than in the DRT group (median, 24.37 months; 95% CI, 15.43-33.31). Multivariate analysis showed that treatment method (hazard ratio [HR]: 2.38, 95% CI, 1.46-3.90; P = 0.001), clinical T stage (HR: 0.57, 95% CI, 0.34-0.95; P = 0.031), and lymph node metastasis (HR: 0.51, 95% CI, 0.31-0.84; P = 0.008) were independent prognostic factors. Regarding subgroup analysis, OS of patients receiving PORT was significantly higher than that of DRT in the T3-4 group (HR: 2.98, 95% CI, 1.80-4.92; P = 0.000) and the N+ group (HR: 2.20, 95% CI, 1.26-3.83; P = 0.006). Conclusions: The efficacy of PORT for the treatment of elderly TESCC patients was superior to DRT. With regard to AACCI, KPS, and age, DRT is still a treatment option for elderly TESCC patients, especially for those >75 years of age.


Assuntos
Quimiorradioterapia/mortalidade , Neoplasias Esofágicas/mortalidade , Carcinoma de Células Escamosas do Esôfago/mortalidade , Esofagectomia/mortalidade , Radioterapia Conformacional/mortalidade , Radioterapia de Intensidade Modulada/mortalidade , Idoso , Terapia Combinada , Neoplasias Esofágicas/patologia , Neoplasias Esofágicas/radioterapia , Neoplasias Esofágicas/cirurgia , Carcinoma de Células Escamosas do Esôfago/patologia , Carcinoma de Células Escamosas do Esôfago/radioterapia , Carcinoma de Células Escamosas do Esôfago/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida
10.
Dan Med J ; 66(8)2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31315797

RESUMO

INTRODUCTION: Minimally invasive oesophagectomy (MIO) has gained increasing popularity. This study reports the results of the first patients operated using this technique at our department. METHODS: All procedures were prospectively registered in a database. Patients were followed until death, two years after surgery or 1 January 2019. RESULTS: A total of 150 procedures were performed (from 23 November 2015 to 27 February 2018). The median proced-ure time decreased from 350 minutes for the initial 75 pa-tients to 320 minutes for the final 75 patients (p < 0.05). Blood loss decreased from 200 ml to 100 ml (p < 0.05), respectively. The conversion rate for the abdominal procedure was 7% for the initial 75 patients and 8% for the final 75 patients (not significant (NS)). For the thoracic procedure, the corresponding figures were 11% and 7% (NS), respectively. Anastomotic leakage was seen in 17% (initial patients) and 11% (final patients) (NS); however, less than 20% of the leakages needed surgical treatment. The median length of post-operative stay was nine days for both groups. For all 150 patients, pulmonary complications were observed in 18% and cardiac complications in 11%. The 30-day mortality rate was 2% and the one-year survival rate was 86% (124 registered patients). CONCLUSIONS: MIO was introduced at our department with acceptable morbidity and mortality rates and the short-term oncological result was not compromised. FUNDING: none. TRIAL REGISTRATION: The study was approved as a quality project by the Region of Southern Denmark (18/37355).


Assuntos
Fístula Anastomótica/cirurgia , Neoplasias Esofágicas/cirurgia , Esofagectomia/mortalidade , Esofagectomia/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Complicações Pós-Operatórias/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Bases de Dados Factuais , Dinamarca , Neoplasias Esofágicas/mortalidade , Feminino , Humanos , Laparoscopia/métodos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/mortalidade , Análise de Sobrevida , Resultado do Tratamento
11.
Ann Surg Oncol ; 26(11): 3736-3744, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31313041

RESUMO

BACKGROUND: Several studies have suggested that thoracoscopic esophagectomy (TE) in the prone position (TEP) may be more feasible than TE in the lateral position (TEL); however, few studies have compared long-term survival between the two procedures. We evaluated whether TEP is oncologically equivalent to TEL. METHODS: Surgical outcomes of TEs performed from January 2006 to December 2013 at our hospital were retrospectively analyzed. Propensity score matching was used to control for confounding factors. RESULTS: TE was performed in 200 patients diagnosed with esophageal squamous cell carcinoma; 78 patients were matched in two procedures. The mean thoracic operative time in TEL was shorter than in TEP (228.9 min vs. 299.1 min; p < 0.001); however, the mean thoracic blood loss in TEL was higher than in TEP (186.9 ml vs. 76.5 ml; p < 0.001). The mean number of thoracic lymph nodes harvested in TEL was lower than in TEP (23.5 vs. 26.9; p < 0.05), and the pulmonary complication rate in TEL was higher than in TEP (30.8% vs. 15.4%; p < 0.05). The 5-year overall survival rates in pathological stage I (81.2% vs. 81.6%; p = 0.82), stage II (65.3% vs. 80.9%; p = 0.21), stage III (26.7% vs. 24.2%; p = 0.86) and all stages (63.6% vs. 62.3%; p = 0.88), and the 5-year progression-free survival rates in pathological stage I (78.0% vs. 81.8%; p = 0.54), stage II (53.5% vs. 77.6%; p = 0.13), stage III (10.5% vs. 12.8%; p = 0.81) and all stages (53.6% vs. 57.9%; p = 0.50) were not significantly different between the two procedures. CONCLUSION: TEP and TEL provide equal oncological efficiency.


Assuntos
Neoplasias Esofágicas/mortalidade , Carcinoma de Células Escamosas do Esôfago/mortalidade , Esofagectomia/mortalidade , Posicionamento do Paciente/mortalidade , Complicações Pós-Operatórias , Toracoscopia/mortalidade , Idoso , Neoplasias Esofágicas/patologia , Neoplasias Esofágicas/cirurgia , Carcinoma de Células Escamosas do Esôfago/patologia , Carcinoma de Células Escamosas do Esôfago/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Prognóstico , Decúbito Ventral , Pontuação de Propensão , Estudos Retrospectivos , Taxa de Sobrevida
13.
Ann Surg Oncol ; 26(9): 2899-2904, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31187365

RESUMO

BACKGROUND: Esophagectomy with three-field lymph node dissection is common, but the effects of cervical lymph node dissection on overall survival in patients with thoracic esophageal cancer remain controversial. Recently, we performed thoracoscopic esophagectomy and superior mediastinum and paracervical esophageal lymph nodes could have been effectively dissected from the thoracic cavity. This study assessed the risks and benefits of prophylactic supraclavicular lymph node dissection in patients who underwent thoracoscopic esophagectomy. METHODS: This retrospective study included 294 patients who underwent thoracoscopic esophagectomy at Kobe University Hospital and Hyogo Cancer Center between April 2010 and December 2015. Patients in the two-field (paracervical esophageal lymph nodes were dissected from the thoracic cavity) and three-field lymph node dissection groups were matched using propensity score matching. We compared overall survival and the incidence of postoperative complications in the matched cohort and assessed the estimated efficacy of additional lymphadenectomy for supraclavicular lymph node recurrence in the entire cohort. RESULTS: In the matched cohort, overall survival was not significantly different between the two groups, but the incidence of recurrent laryngeal nerve palsy was significantly higher in the 3FL group than in the 2FL group. In the entire cohort, 162 patients underwent a two-field lymph node dissection; 11 experienced supraclavicular nodal recurrence. We performed additional supraclavicular lymph node dissection in three patients without systemic metastasis, all of whom are alive without any other recurrence. CONCLUSIONS: Prophylactic cervical lymph nodes dissection in thoracoscopic esophagectomy does not improve long-term survival but does increase the risk of postoperative complications.


Assuntos
Neoplasias Esofágicas/cirurgia , Carcinoma de Células Escamosas do Esôfago/cirurgia , Esofagectomia/mortalidade , Excisão de Linfonodo/mortalidade , Linfonodos/cirurgia , Complicações Pós-Operatórias , Neoplasias Torácicas/cirurgia , Toracoscopia/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Neoplasias Esofágicas/patologia , Carcinoma de Células Escamosas do Esôfago/secundário , Feminino , Seguimentos , Humanos , Linfonodos/patologia , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida , Neoplasias Torácicas/patologia
14.
World J Surg ; 43(10): 2483-2489, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31222637

RESUMO

BACKGROUND: Several techniques have been described for esophagogastric anastomosis following esophagectomy. This study compared the outcomes of circular stapled anastomoses with semi-mechanical technique using a linear stapler. METHODS: Perioperative data were extracted from a contemporaneously collected database of all consecutive esophagectomies for cancer with intrathoracic anastomoses performed in the Trent Oesophago-Gastric Unit between January 2015 and April 2018. Anastomotic techniques: circular stapled versus semi-mechanical, were evaluated and outcomes were compared. The primary outcome was anastomotic leak rate. Secondary outcomes included anastomotic stricture, overall complication rates, length of stay (LOS) and 30 day all-cause mortality. RESULTS: One hundred and fifty-nine consecutive esophagectomies with intrathoracic anastomosis were performed during the study period. There were no significant differences between the two groups in terms of age, American Society of Anaesthesiologists score, Charlson comorbidity index and neoadjuvant therapies received. Circular stapled anastomoses were performed in 85 patients, while 74 patients received a semi-mechanical anastomosis. Clavien-Dindo complications II or more were higher in the circular stapled group (p = 0.02). There were 16 (10%) anastomotic leaks overall, three (4%) in semi-mechanical group versus 13 (15%) in the circular stapled group (p < 0.019). There was no statistically significant difference between the two groups in terms of LOS, 30-day mortality or the need for endoscopic dilatation of the anastomosis at 3 months follow-up. CONCLUSION: The move from a circular stapled to a semi-mechanical intrathoracic anastomosis has been associated with a reduced postoperative anastomotic leak rate following esophagectomy for esophageal cancer.


Assuntos
Anastomose Cirúrgica/métodos , Neoplasias Esofágicas/cirurgia , Esofagectomia/métodos , Grampeamento Cirúrgico/métodos , Idoso , Anastomose Cirúrgica/efeitos adversos , Fístula Anastomótica/epidemiologia , Bases de Dados Factuais , Esofagectomia/instrumentação , Esofagectomia/mortalidade , Feminino , Seguimentos , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Técnicas de Sutura , Resultado do Tratamento
15.
Ann Surg Oncol ; 26(9): 2890-2898, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31183641

RESUMO

BACKGROUND: Effective tools evaluating the prognosis for patients with esophageal cancer undergoing surgery is lacking. The current study aimed to develop a nomogram to predict overall survival (OS) and provide evidence for adjuvant therapy for patients with esophageal carcinoma after esophagectomy. METHODS: The study retrospectively reviewed patients with pathologic T1N +/T2-4aN0-3, M0 thoracic esophageal squamous cell carcinoma after radical esophagectomy, with or without adjuvant therapy, in one institution as the training cohort (n = 2281). A nomogram was established using Cox proportional hazard regression to identify prognostic factors for OS, which were validated in an independent validation cohort (n = 1437). Area under curve (AUC) values of receiver operating characteristic curves were calculated to evaluate prognostic efficacy. RESULTS: In the training cohort, the median OS was 50.46 months, and the 5-year OS rate was 47.08%. Adjuvant therapy, sex, tumor location, grade, lymphovascular invasion, removed lymph nodes, and T and N categories were identified as predictive factors for OS. The nomogram showed favorable prognostic efficacy in the training and validation cohorts (5-year OS AUC: 0.685 and 0.744, respectively), which was significantly higher than that of the American Joint Committee on Cancer (AJCC) staging system. The nomogram distinguished OS rates among six risk groups, whereas AJCC could not separate the OS of 2A and 1B, 3C and 3B, or 3A and 2B. Patients with a nomogram score of 72 to 227 were predicted to achieve a 5-year OS increase of 10% or more from adjuvant therapy. CONCLUSION: The nomogram could effectively predict OS and aided decision making in adjuvant therapy for patients with thoracic esophageal squamous cell carcinoma after esophagectomy.


Assuntos
Neoplasias Esofágicas/mortalidade , Carcinoma de Células Escamosas do Esôfago/mortalidade , Esofagectomia/mortalidade , Nomogramas , Neoplasias Torácicas/mortalidade , Idoso , Neoplasias Esofágicas/patologia , Neoplasias Esofágicas/cirurgia , Carcinoma de Células Escamosas do Esôfago/patologia , Carcinoma de Células Escamosas do Esôfago/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Curva ROC , Estudos Retrospectivos , Taxa de Sobrevida , Neoplasias Torácicas/patologia , Neoplasias Torácicas/cirurgia
16.
Ann Thorac Cardiovasc Surg ; 25(5): 253-259, 2019 Oct 20.
Artigo em Inglês | MEDLINE | ID: mdl-31189775

RESUMO

PURPOSE: To evaluate prognosis of patients with esophageal carcinoma undergoing pulmonary metastasectomy, and help determine appropriate therapeutic strategies. METHODS: We retrospectively studied 16 patients (15 men and one woman; median age 66.5 years) with esophageal carcinoma, who underwent curative resection of pulmonary metastases. Clinical characteristics and surgical outcomes were analyzed. RESULTS: In all, 11 patients underwent wedge resection, three segmentectomy, and two lobectomies. The average operating time and blood loss were 147 min and 103 mL, respectively. There were no perioperative deaths or severe complications. Five-year overall survival rate was 40.2% and 2-year disease-free survival rate was 35.2%. All recurrences occurred within 2 years. Univariate and multivariate analyses revealed that absence of adjuvant chemotherapy after therapy for esophageal carcinoma was a significant predictor of poor prognosis and recurrence, respectively (p <0.05). The prognosis of seven patients who underwent esophagectomy with adjuvant chemotherapy was better than that of the other nine patients (p = 0.0166). CONCLUSION: Pulmonary metastasectomy in patients with esophageal carcinoma was only one choice of multimodal treatment, and perioperative chemotherapy was important for long-term survival after pulmonary metastasectomy. Pulmonary metastasectomy was effective in patients undergoing esophagectomy with adjuvant chemotherapy.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Carcinoma/terapia , Neoplasias Esofágicas/terapia , Esofagectomia , Neoplasias Pulmonares/terapia , Metastasectomia/métodos , Pneumonectomia , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Carcinoma/mortalidade , Carcinoma/secundário , Quimioterapia Adjuvante , Cisplatino/administração & dosagem , Esquema de Medicação , Neoplasias Esofágicas/mortalidade , Neoplasias Esofágicas/patologia , Esofagectomia/efeitos adversos , Esofagectomia/mortalidade , Feminino , Fluoruracila/administração & dosagem , Humanos , Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/secundário , Masculino , Metastasectomia/efeitos adversos , Metastasectomia/mortalidade , Pessoa de Meia-Idade , Pneumonectomia/efeitos adversos , Pneumonectomia/mortalidade , Intervalo Livre de Progressão , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo
17.
Anticancer Res ; 39(6): 3167-3175, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31177163

RESUMO

BACKGROUND/AIM: Unresectable oesophageal cancer with surrounding invasion carries a particularly poor prognosis. The chemoradiotherapy treatment for locally-unresectable oesophageal cancer aims to initially control local invasion before proceeding to the next treatment, and is ideally used with curative intent. The aim of this study was to investigate patient treatment course and survival to determine the best treatment and evaluate surgical intervention for these advanced cancers. PATIENTS AND METHODS: A total of 147 patients who were diagnosed with clinical T4b oesophageal cancer were included in this study. RESULTS: Forty-three patients had undergone curative resection of the tumour and surrounding invasion at midterm evaluation, 104 patients continued with definitive chemoradiotherapy, and salvage surgery was performed in 21 patients. Multivariate analysis of disease-specific survival showed that response at the midterm evaluation and surgical intervention (conversion surgery + salvage surgery) were significant prognostic factors. CONCLUSION: Surgical intervention was an independent prognostic factor, and operation should be performed in eligible patients after considering the risks and proper timing.


Assuntos
Quimiorradioterapia Adjuvante , Neoplasias Esofágicas/terapia , Carcinoma de Células Escamosas do Esôfago/terapia , Esofagectomia , Terapia Neoadjuvante , Idoso , Quimiorradioterapia Adjuvante/efeitos adversos , Quimiorradioterapia Adjuvante/mortalidade , Tomada de Decisão Clínica , Neoplasias Esofágicas/mortalidade , Neoplasias Esofágicas/patologia , Carcinoma de Células Escamosas do Esôfago/mortalidade , Carcinoma de Células Escamosas do Esôfago/patologia , Esofagectomia/efeitos adversos , Esofagectomia/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante/efeitos adversos , Terapia Neoadjuvante/mortalidade , Invasividade Neoplásica , Estadiamento de Neoplasias , Seleção de Pacientes , Estudos Retrospectivos , Fatores de Risco , Terapia de Salvação , Fatores de Tempo , Tempo para o Tratamento , Resultado do Tratamento
18.
Ann Surg Oncol ; 26(7): 2090-2103, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30937663

RESUMO

BACKGROUND: The association between body mass index (BMI) and short-term outcomes after esophagectomy remains controversial. METHODS: A meticulous search for articles describing the association between BMI and perioperative outcomes after esophagectomy was conducted using PubMed, EMBASE, and the Cochrane Library. The study classified BMI according to the World Health Organization definitions and Asian-specific BMI cutoff values. Normal weight was selected as the comparator, and the odds ratio (OR) was calculated as the primary effect. RESULTS: This meta-analysis included 13 studies with 5480 patients. Obese patients exhibited higher risks of overall complication (OR 1.37; P = 0.013), anastomotic leakage (OR 1.74; P = 0.001), and thromboembolic complications (OR 2.05; P = 0.039). Subgroup analysis indicated that obese patients from Western countries had a higher risk of wound infection (OR 2.22; P = 0.022), whereas obese Asians were more likely to experience pulmonary complications (OR 1.64; P = 0.002). Overweight patients displayed no significant differences in major complications relative to normal-weight patients, except for the increased risk of overall complications (OR 1.32; P = 0.030). Additionally, underweight patients showed increased incidence of pulmonary complications (OR 1.92; P = 0.020 and anastomotic leakage (OR 1.64; P = 0.034). Morbid obesity also was analyzed separately with limited data, and this group displayed a higher risk of wound infection (OR 1.62; P = 0.027) and thromboembolic complications (OR 2.65; P = 0.003). No significant differences in mortality were observed among patients in different BMI categories. CONCLUSIONS: Obesity and underweight statuses were confirmed risk factors for several complications after esophagectomy, whereas overweight patients tended to experience greater benefit from surgery.


Assuntos
Índice de Massa Corporal , Neoplasias Esofágicas/mortalidade , Esofagectomia/mortalidade , Sobrepeso/mortalidade , Complicações Pós-Operatórias/mortalidade , Magreza/mortalidade , Neoplasias Esofágicas/cirurgia , Humanos , Prognóstico , Fatores de Risco , Taxa de Sobrevida
19.
Ann Surg Oncol ; 26(7): 2081-2089, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30937664

RESUMO

BACKGROUND: Postoperative complications have a negative impact on overall survival after esophagectomy because systemic inflammation may induce residual cancer cell growth. A solution that could suppress micrometastasis is neoadjuvant therapy; however, to date, no study has shown that neoadjuvant therapy suppresses proliferation of cancer cells due to postoperative complications after esophagectomy. The aim of this study is to investigate the influence of neoadjuvant therapy on poor long-term outcomes of postoperative complications in patients with esophageal carcinoma. PATIENTS AND METHODS: In total, 431 patients who underwent esophagectomy for esophageal squamous cell carcinoma were included in this study. We investigated the relationship between complications, such as pneumonia, and long-term oncologic outcomes with and without neoadjuvant therapy. RESULTS: Among the patients, the 3-year overall survival (OS) rate was 69.5% and the disease-free survival (DFS) rate was 59.0%. The patients were categorized into two groups: the neoadjuvant therapy (+) group (n = 217) and neoadjuvant therapy (-) group (n = 214). Among patients not undergoing neoadjuvant therapy, patients with pneumonia or pyothorax had significantly poorer OS and DFS than patients without these complications. However, among patients undergoing neoadjuvant therapy, there were no significant differences in long-term outcomes, regardless of presence of complications. On multivariate analysis, pneumonia (p = 0.003), pyothorax (p < 0.001), and chylothorax (p = 0.002) were identified as predictors of death in the neoadjuvant therapy (-) group. CONCLUSION: The negative impact of postoperative complications on long-term prognoses can be reduced by performing neoadjuvant therapy in patients with esophageal carcinoma.


Assuntos
Quimiorradioterapia Adjuvante/mortalidade , Neoplasias Esofágicas/mortalidade , Carcinoma de Células Escamosas do Esôfago/mortalidade , Esofagectomia/mortalidade , Terapia Neoadjuvante/mortalidade , Recidiva Local de Neoplasia/mortalidade , Complicações Pós-Operatórias/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Terapia Combinada , Neoplasias Esofágicas/patologia , Neoplasias Esofágicas/terapia , Carcinoma de Células Escamosas do Esôfago/patologia , Carcinoma de Células Escamosas do Esôfago/terapia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/terapia , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida
20.
Medicine (Baltimore) ; 98(14): e15029, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30946339

RESUMO

BACKGROUND: The prognostic significance of tumor length in esophageal cancer (EC) remains controversial. Hence, we conducted a meta-analysis to quantitatively assess the prognostic significance of tumor length in EC patients. METHOD: A systematic literature search was conducted in the PubMed, EMBASE, and Web of Science. Hazard ratios (HRs) with their 95% confidence intervals (CIs) were used to assess the prognostic significance of tumor length for overall survival (OS), and disease-free survival (DFS) in EC patients. RESULTS: A total of 21 articles with 22 eligible studies involving 9271 patients were included in this meta-analysis. The results of our pooling analyses demonstrated that tumor length was an independent prognostic parameter for OS (HR = 1.38, 95% CI: 1.24-1.54, P < .01) and DFS (HR = 1.29, 95% CI: 1.11-1.50, P < .01) in EC patients. Moreover, our subgroup analysis and sensitivity analysis showed that the pooled HRs assessing the prognostic significance of tumor length did not significantly fluctuated, suggesting our pooling analyses were stable and reliable. CONCLUSION: The results of this meta-analysis demonstrated that long tumor is an independent risk of poor OS and DFS in EC patients, suggesting that it may provide additional prognostic information and thus contribute to a better stratification of EC patients, especially for those with no lymph node metastasis. However, more well-designed prospective clinical studies with large sample size are needed to strength our conclusion due to several limitations in this meta-analysis.


Assuntos
Neoplasias Esofágicas/mortalidade , Neoplasias Esofágicas/patologia , Esofagectomia/mortalidade , Carga Tumoral , Intervalo Livre de Doença , Neoplasias Esofágicas/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Modelos de Riscos Proporcionais , Resultado do Tratamento
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